Q: I keep hearing about topical retinoids. What do they do?A: In recent years scientific studies have shown that Retin-A, retinoic acid or tretinoin, may have effect if used for 6-12 months in reversing some skin problems. This is in contrast to the myriad of cosmetic products which make inflated claims (in addition to having inflated prices), and which lack scientific validity (like the products for sale at your local department store!)

Retin-A is a synthetic derivative of naturally occurring vitamin A which may work by its effect on the way cells differentiate and mature. It helps to make the skin more evenly pigmented and have more of a dewy appearance or glow.

In young and middle-aged individuals, chronic sun damage is the major contributing factor to aging of the skin. Sun damaged skin shows fine wrinkling, thinning, roughening, irregular pigmentation (freckling and white spots), a leathery appearance and precancerous rough spots. Therefore, we stress to all our patients, regardless of how else they care for their skin, to use of full strength sunscreens (SPF 30 or greater) to prevent further aging of the skin and to perhaps allow the reversal of some of the damage already done. Lower strength (less than 30 SPF) sunscreens are not effective in preventing damage.

Retin-A should be used as follows:

Wash your face no more than twice a day with a mild soap. Avoid harsh abrasive soaps or scrubs. The use of astringents, clarifiers, toners, or purifying lotions should be minimized as advised.

After washing your face at bedtime, pat your face dry with a towel, don't rub. Apply Retin-A lightly to areas being treated and leave on overnight. Apply your regular moisturizing cream in the morning to prevent drying and peeling. You do not have to wash your face at bedtime before applying Retin-A.

Be careful using Retin-A at the corner of the mouth, nose, eyes, and other sensitive areas which chap easily. Avoid excessive unprotected exposure to the sun, as well as wind and cold, since these tend to dry and burn skin more readily in a n individual using Retin-A. As discussed above, a 30SPF sunscreen should be used. If you go to the beach or skiing, you may need to cut down or stop the Retin-A. Avoid waxing as well.

Patients with dry, sensitive or fair skin should start out using the medication every other night for 2-4 weeks, after which time nightly application will usually be tolerated. If not tolerated, you may need a milder concentration of Retin-A.

Some mild redness and peeling may occur during the first few weeks of treatment. If excessive redness, peeling, drying or crusting occurs, discontinue use of the medication for several days to allow your face to recover before resuming application.

Sometimes stinging occurs around the eyes with soap and water, sun screens, etc. This usually resolves with time and use of a moisturizer.

After several weeks to months some discrete rough, red scaly spots may surface. These are precancerous keratoses which would have emerged in the future and now are in the process of being destroyed.

It take 6-12 months to see the full effect of improvement of Retin-A and then a maintenance schedule is begun of applications 2-3 times a week.

If you begin to notice broken blood vessels in the areas in which you are using Retin-A, stop applying Retin-A to these areas.

If you are of childbearing age and are anticipating a pregnancy, discontinue the use of Retin-A prior to becoming pregnant.

If you are always in the sun, you probably should not use Retin-A.

Ultra-A

This is Jenna’s favorite – Vi Derm’s ‘Ultra A.’ She loves it because it works, it saves time – and money! It contains not only Retin A but the following:

0.1% Tretinoin (Retin A) which is the strongest prescription strength available

Contains BHT which is a strong anti-oxidant that some people even take in pill form because some research has suggested that is can help prevent cancer

Vitamin C 10% (Usually sold separately in most skin-care systems. By combining the 2 products you save time and money!)